Enroll in ObamaCare?

[CaptHaddock]

BTW, if anyone knows the answer to this, I'd appreciate it:

Starting with 2014 under the ObamaCare law, U.S. residents cannot be DENIED health insurance coverage by private insurers because of pre-existing conditions. That means, you still can get health insurance.

But, does it also mean that the insurers cannot EXCLUDE pre-existing conditions from coverage? Or just that they have to provide an insurance policy, but still can exclude specific conditions from coverage under that policy?

They cannot exclude coverage for pre-existing conditions. If you were to continue your prior, non-ACA insurance coverage which excluded pre-existing conditions, it would continue to do so. But not a new, ACA policy.

[Mrjlh]

I was wondering what it would take to get there medicare if I was to move there. I am receiving a SS payment. I chose not to join it as I was not living there even though I am US citizen.

Is it based on the amount of SS you receive?

What you are talking about is Medicare Part B.

When you are eligible for Part B, which is one year after you start receiving social security benifits (65, 66, or 67 which ever one applies) you have 6 months to accept it. It is currently $104.90 a month, period. If you don't sign up you are penalized 10% for every year you do not sign up. So if you never plan on returning no problem, but if things change and you do, You suffer the consequences. How would they know? Simply go to a doctor when you return. If you have private insurance they too have the option of billing medicare. So you get caught there too. Plus yo might even get caught in good old Bamacare.

Your best source of information is http://www.ssa.gov/

This is not correct. You are eligible for Medicare at age 65 if you have worked long enough, i.e. 40 quarters, to qualify for Social Security. You do not have actually to be collecting SS nor do you have to wait until Full Retirement Age or any other age. Under certain circumstances you could be eligible before age 65, but you never have to wait longer than age 65.

Taken directly from SS website which I posted for the correct information because even I can't remember every detail:

Hospital insurance (Part A)

Most people age 65 or older who are citizens or permanent

residents of the United States are eligible for free Medicare

hospital insurance (Part A). You are eligible at age 65 if:

• You receive or are eligible to receive Social Security

benefits; or

• You receive or are eligible to receive railroad retirement

benefits; or

• Your spouse receives or is eligible to receive Social

Security or railroad retirement benefits; or

• You or your spouse (living or deceased, including

divorced spouses) worked long enough in a government

job where Medicare taxes were paid; or

• You are the dependent parent of a fully insured

deceased child.

If you do not meet these requirements, you may be able

to get Medicare hospital insurance by paying a monthly

premium. Usually, you can sign up for this hospital

insurance only during designated enrollment periods.

(The underlined sentence means you do not need 40 quarters to qualify. You pay extra for this and I can't find the formula they use. I may be the same rate as every one else.)

NOTE: Even though the full retirement age is no longer

65, you should sign up for Medicare three months before

your 65th birthday. You can apply on our website at

www.socialsecurity.gov.

(Further: there are sign up rules depending when you apply for your medicare. Nice chart to follow. You have up to 7 months to enroll not the 1 year as I said. My mistake)

Again go to the website and get the correct information. And while you are there you can sign up if you are eligible.

http://www.ssa.gov/pgm/medicare.htm

[Mrjlh]

We are learning there are a crap load of errors with what Obama-care promised and what you can really do. Reports of Doctors dropping out which they are entitled to do. Frankly, it's a pile of crap that gets more complicated than its worth. I suspect the whole system will be scrapped by Congress this year.

[ThaiBob]

We are learning there are a crap load of errors with what Obama-care promised and what you can really do. Reports of Doctors dropping out which they are entitled to do. Frankly, it's a pile of crap that gets more complicated than its worth. I suspect the whole system will be scrapped by Congress this year.

The system will be tweaked over time but even Foxnews and the Republican party are resigned to the fact Obamacare is here to stay. A real shame, a single payer system was the way to go, just shows the power of the AMA and insurance companies.

[ThaiBob]

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It is an interesting question.

I do know, when I was working in the U.S., I had an employment related medical insurance thru Blue Cross that did include coverage at some selected hospitals in Thailand. So yes, some regular U.S. health insurance policies do include coverage when traveling abroad/outside the U.S.

However, I believe obtaining those kinds of policies from stratch would require residence in some particular U.S. state. Now, what kind of "residence" would suffice is an interesting question. A mail address? A family address?? I'm not sure.

My concern about that approach would be paying premiums over time, and then at some point, the insurance company coming to the conclusion that you're not really insurable under their rules. Or you start having medical claims all outside the U.S. and none in your designated home state... Is that going to catch someone's attention at some point?

Just as jingthing said most major U.S. insurance companies will reimbrse you if while traveling overseas you have a medical emergency, but if they find out you are living overseas full time they will stop paying in a heartbeat! I don't know why anyone would pay for private medical insurance in the states when they are living over in Thailand, since Thai medical insurance is so much cheaper and you wouldn't have to submit for reimbursement ?

I have a Medicare senior advantage plan that is administered by Anthem BC and part of my former employer's health plan portfolio. The plan only pays 70% of claims but it is better than nothing. Thanks to Obamacare no preexisting exclusions. Claims are paid worldwide and I can use the Anthem BC panel of doctors/hospitals where they have service agreements. For example, Bumrungrad is on the list with over another 100 or so hospitals here in Thailand. These plans are not typical.

[TallGuyJohninBKK]

Yep... that's the kind of health insurance based on prior employment that I was talking about. And in those cases, I believe you could continue to live abroad and not run into trouble.

But I'm afraid it's an entirely different matter when someone wants to sign up on their own (not part of employment or retirement benefits) for a U.S. health insurance policy. AFAIK, that has to be done for regular health insurance policies with a state-based "residence" of some kind.

A person living abroad probably could get into that ballgame, if they handled everything carefully by using and keeping a U.S. address of some kind. But whether they'd be able to successfully maintain and use that insurance over time, while living abroad and all or most of the claims coming from abroad, seems to me to be a dicey proposition.

If anyone's managed to do it successfully, I'd sure like to hear about it.

[Sheryl]

Me too, especially if done through Medicare Advantage.

[ThaiBob]

Me too, especially if done through Medicare Advantage.

These plans are not that common but they do exist, especially for former government workers, educators, international companies. I do have a U. S. address in theory but my plan only pays 70% so when my U.S. claim is first processed by Medicare the plan is reimbursed 80% but pays me 70 so they are making money on me(10%). It also has a higher than average deductible. If the claim is foreign the plan pays me but at a fraction of the cost of a U.S. claim. Once the high annual deductible is met, I pay nothing. I know former government workers where the payback is 100% and we are not just talking about emergency services when traveling in a foreign country.

[TallGuyJohninBKK]

I have a Medicare senior advantage plan that is administered by Anthem BC and part of my former employer's health plan portfolio.

Dont want to be a broken record here...but...

People who have gained entitlements to health insurance coverage as part of their past employment or retirement benefits in the U.S. are in pre-existing group plans that they can continue in as long as they keep paying the premiums. There's no qualification issue involved.

That's an entirely different matter from individuals living outside the U.S. who might be trying to obtain, keep and use NEW private individual medical insurance from U.S. insurers.

I worked in the public sector before, and had I retired later, I could have qualified for and kept my government health insurance, I'm pretty sure, regardless of where I lived in the future. I might not have had all the same benefits for claims originating outside the U.S., but my continuing coverage wouldn't have been an issue.

I don't believe a private person seeking an individual private health insurance policy in the U.S. can expect the same treatment from a potential insurer.

[ThaiBob]

I have a Medicare senior advantage plan that is administered by Anthem BC and part of my former employer's health plan portfolio.

Dont want to be a broken record here...but...

People who have gained entitlements to health insurance coverage as part of their past employment or retirement benefits in the U.S. are in pre-existing group plans that they can continue in as long as they keep paying the premiums. There's no qualification issue involved.

That's an entirely different matter from individuals living outside the U.S. who might be trying to obtain, keep and use NEW private individual medical insurance from U.S. insurers.

I worked in the public sector before, and had I retired later, I could have qualified for and kept my government health insurance, I'm pretty sure, regardless of where I lived in the future. I might not have had all the same benefits for claims originating outside the U.S., but my continuing coverage wouldn't have been an issue.

I don't believe a private person seeking an individual private health insurance policy in the U.S. can expect the same treatment from a potential insurer.

You are right, I will zip it.

[TallGuyJohninBKK]

Me too, especially if done through Medicare Advantage.

The Americans Abroad website has a long info page on Medicare issues for those living outside the U.S., including a discussion of the Medicare Advantage plans (Part C).

Their info re Part C plans includes the following:

Part C is called Medicare Advantage Plans

(private group health care plans approved by Medicare – available only within the US).

Anyone who has both Medicare Part A and Part B is eligible. If you move back to the US after living abroad, you can join for the first 2 full months after the month you move back.

http://americansabroad.org/issues/healthcare/general-information-about-medicare/

More broadly on the subject of Medicare, they appear to be saying that expats living abroad probably should enroll in Medicare Part A (hospital insurance), which pretty much comes along with Social Security at no added cost, once they reach age 65.

They also suggest it might make sense for expats to sign up and pay for the premiums associated with Medicare Part B (doctor's fees), because the premiums increase markedly for every year a person doesn't enroll after becoming eligible. Even though, the Part B coverage basically doesn't provide any benefit while someone is living in Thailand, but would if later in life they went back to the U.S.

The Association of Americans Resident Oversees also has a page on Medicare issues for expats, taking a broader overview of how expats aren't covered but probably should be.

http://www.aaro.org/medicare

Edited February 23, 2014 by TallGuyJohninBKK

[Sheryl]

Useful links, thanks

[CharlesWayne]

Bona fide expats are not required to have U.S. based health insurance. In other words, they are EXEMPT from the Obamacare MANDATE.

U.S. based health insurance is useless in Thailand.

If you are not a bona fide expat, you are obligated to obtain U.S. based health insurance or face penalties.

Based on my understanding, any year that you spend more than THIRTY DAYS in the USA would put you OUT of the bona fide expat category.

ObamaCare is not a SPECIFIC insurance product. It's just an alternative name for the Affordable Care Act.

For private health insurance in Thailand there are lots of options but keep in mind health exclusions for preexisting conditions apply and not everyone would even be insurable at all, just as in the pre-Obamacare USA.

It is not accurate that US based insurance is useless. The fact is that US carriers are thrilled you get medical care in Thailand because it costs them less. There are many hospitals in Thailand that get direct pay from US insurance.

I had surgery and Blue Cross/Blue Shield waived my co-pay. They paid a 500K baht tab without any problem at all.

Edited February 24, 2014 by CharlesWayne

[CMBob]

Speaking only about the "C" option of Medicare (a/k/a medicare advantage plans) and not including in my discussion any variant (where you've gotten it through any type of government employment or through a big employer who has specialized/negotiated plans), I was specifically told by the plans (again, medicare advantage providers) offered in my state (Michigan) that I cannot buy such a plan unless I'm a resident of the US for at least 6 months a year. So for the guy/gal who is of medicare age/eligibility who wants to buy your own medicare advantage coverage, you apparently can't do it if you live outside the US for more than 6 months a year.

Additionally, every medicare advantage plan (again, folks, I'm not talking about some governmental or big company hybrid here) contains a provision that it will cover for emergency care (and that's rather strictly defined) outside the United States only during the first 60 days during your trip outside the US.

Since I stay in Thailand 9 months a year, I can't buy a medicare advantage plan...plus, I suppose, I wouldn't waste the money to pay all year for coverage that's limited and only during the first 60-days I'm outside the US. For others, maybe it'd make sense but I sincerely doubt it unless you're in the US most of the year.

Going back to part of the original question, you don't have to comply with the Affordable Care Act at all (and there are no penalties if you don't) if you're covered by Medicare part A.

[soisanuk]

Below is a link to the US State Dept information regarding the ACA (Obamacare) and notes the requirements for those living abroad to be exempt - it also notes that to use the "Exchanges" set up under the ACA to purchase health insurance, you must live in USA. - so for most full time Expats, it does not appear that they could purchase health insurance in the ACA "Marketplaces."

http://travel.state.gov/content/passports/english/abroad/legal-matters/benefits.html

Someone else has posted a link for information about medicare - which doesn't cover you for treatment outside the USA (there is an exception, but it relates to being treated at the nearest hospital that can provide treatment, e.g., Canada and Mexico if you are close to border and a hospital in those countries is closer). If I recall correctly, some of the Advantage plans will cover emergency treatment if you are overseas, but I think there is a time limit on how long you can be out of the country for that coverage to apply.

Yes, there are some folks with USA health insurance policies that will cover them outside the USA including Thailand, but as mentioned, most of these are policies that were provided by their employer and carried over into retirement. The extent of coverage will depend on the type of policy you have. I have such a policy, being a retired Federal Government employee (there are different policies available to Fed Gov't employees - I have Blue Cross Blue Shield specifically because it does cover me outside the USA). For outpatient visits, I pay and file claim for reimbursement, which is 85%. For inpatient, I use Bangkok Hospital Pattaya and they direct bill my insurance through their overseas service company.

[Suradit69]

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Jingthing

You said: "U.S. based health insurance is useless in Thailand."

Totally incorrect! I have U.S. based med insurance, have had this since I returned 20+ years back. Submit my receipts and am reimbursed at about 80%, higher in some cases. Note, this is not TriCare related which is for U.S. military retirees.

All depends on your U.S. insurance company and I've been with this one for perhaps 30 years.

Mac

In my experience, U.S. based health insurance is for U.S. RESIDENTS. In fact aren't you required to have any actual U.S. STATE residence? Are you talking about U.S. based insurance that covers you on TRIPS? If not, please supply much more detail. Thank you.

In any case, why would an EXPAT in Thailand want to spend MUCH MORE MONEY for full time U.S. based coverage if they LIVE in Thailand, even if they could purchase it? OK, well, I can think of one reason. Now with Obamacare, you can get U.S. based insurance with preexisting conditions but I still think you would need a REAL U.S. state residence to buy that. That would be interesting to an expat in Thailand who is UNINSURABLE in Thailand.

"In any case, why would an EXPAT in Thailand want to spend MUCH MORE MONEY for full time U.S. based coverage if they LIVE in Thailand,"

I too have US based health insurance. I don't pay premiums for it because it's part of my retirement benefits. I had BUPA before I turned 65, but from 65 until death I'm covered without premiums. Whether I live in the US or overseas, I get 80% of prescription drugs, doctor and hospital charges, eye glasses, dental expenses, etc. I submit receipts every two to three months and the claim is paid directly into my Chicago bank. Obviously for both me and the insurer things are cheaper here than if I were living in the US.

I also receive monthly Social Security payments and was automatically enrolled into the basic Medicare (or so I was told by letter from Medicare), but those benefits aren't available to someone permanently resident overseas.

Edited February 24, 2014 by Suradit69

[phuketrichard]

Bona fide expats are not required to have U.S. based health insurance. In other words, they are EXEMPT from the Obamacare MANDATE.

U.S. based health insurance is useless in Thailand.

If you are not a bona fide expat, you are obligated to obtain U.S. based health insurance or face penalties.

Based on my understanding, any year that you spend more than THIRTY DAYS in the USA would put you OUT of the bona fide expat category.

ObamaCare is not a SPECIFIC insurance product. It's just an alternative name for the Affordable Care Act.

For private health insurance in Thailand there are lots of options but keep in mind health exclusions for preexisting conditions apply and not everyone would even be insurable at all, just as in the pre-Obamacare USA.

True;

but penilty is less than $100./year

so dont get it if u live in American an than if u get sick pay the penalty an ur covered as they can NOT refuse you.

as an expat ( an if u file the 2555) u are not required to have it

[NeverSure]

NeverSure and VegasVic, you both talk above about participating in the Medicare program, NeverSure for himself and VegasVic for his wife.

NeverSure, you seem to be saying you're paying for MediCare while living all or most of the time in Thailand. Did you enroll in Medicare before moving here, or after moving here? And, have you had any difficulties with being enrolled while living here?

Vegas, you talked about your wife, but don't seem to say if you're living in the U.S. or Thailand while using Medicare?

Afterall, the thread here is about the potential for expats to enroll in ObamaCare or things like Medicare.

I am careful NOT to live in Thailand. I visit a couple of times a year for a few months. I'm fortunate enough to be able to own a home in the US which is always ready for me complete with vehicles. This is because I have a medical condition which is not really debilitating and certainly not life threatening, but monitoring it is VERY expensive. I wouldn't trust it to Thai doctors, either.

So I maintain Medicare Medigap for about $270 per month, US residency, and once a year go to a US medical university and teaching hospital and have very expensive tests. My medical care costs me nothing beyond my premiums.

To answer others, those 65 or older are exempt from Obamacare due to Medicare. And no, no one can ding you any more for pre-existing conditions. Well, they do ding you of course being private insurance companies, but they do it by raising everyone's rates and deductibles.

[rotary]

Bona fide expats are not required to have U.S. based health insurance. In other words, they are EXEMPT from the Obamacare MANDATE.

U.S. based health insurance is useless in Thailand.

If you are not a bona fide expat, you are obligated to obtain U.S. based health insurance or face penalties.

Based on my understanding, any year that you spend more than THIRTY DAYS in the USA would put you OUT of the bona fide expat category.

ObamaCare is not a SPECIFIC insurance product. It's just an alternative name for the Affordable Care Act.

For private health insurance in Thailand there are lots of options but keep in mind health exclusions for preexisting conditions apply and not everyone would even be insurable at all, just as in the pre-Obamacare USA.

Not sure how it is on Obummercare but for tax purposes there are two ways to get that earned income exclusion:

(1)Spend less than 30 days a year in the USA which is called PHYSICAL PRESENCE. The best and easy way

(2)Claim Bona Fide Residence by showing that you are a resident of a foreign country

My guess, and it needs confirmed, either one would get you out of Obummercare.

For insurance try BUPA with a high deductible which is really only good for major things.

[Sheryl]

I believe you are right, they are piggy-backing onto the existing IRS system.

Where it will be a potential problem is for people who have no earned income (retirees, for example) and thus no need to file a form 2555, especially if for one reason or another they file from a US address. Changing to filing from one's Thai address, and perhaps enclosing a statement to the effect that you have established a bona fide residence in Thailand since (date) would probably resolve that. For those of us who file 2555 anyhow, no problem at all.

[soisanuk]

It appears from this IRS publication that demonstrating you have health insurance if required or that you are exempt will apply to the 2014 income tax return (filed in 2015). Further, that as of now, the means of doing so on the 2014 income tax return has not yet been established and will be forthcoming later. Also note that to collect the "shared responsibility" payment, the IRS cannot use liens or levies as they do for income tax, but if you have an income tax refund due, they can offset the payment against any refund.

http://www.irs.gov/uac/Questions-and-Answers-on-the-Individual-Shared-Responsibility-Provision

25. Will I have to do something on my federal income tax return to show that I had coverage or an exemption?

The individual shared responsibility provision goes into effect in 2014. You will not have to account for coverage or exemptions or to make any payments until you file your 2014 federal income tax return in 2015. Information will be made available later about how the income tax return will take account of coverage and exemptions. Insurers will be required to provide everyone that they cover each year with information that will help them demonstrate they had coverage beginning with the 2015 tax year.

26. What happens if I do not have minimum essential coverage or an exemption, and I cannot afford to make the shared responsibility payment when filing my tax return?

The IRS routinely works with taxpayers who owe amounts they cannot afford to pay. The law prohibits the IRS from using liens or levies to collect any individual shared responsibility payment. However, if you owe a shared responsibility payment, the IRS may offset that liability against any tax refund that may be due to you.

[dzodun]

Mania, I believe the U.S. is part of a global government movement to know the whereabouts and personal

details of every citizen under its control. This includes your income and bank accounts, wherever they are.

There is a form all U.S. citizens must fill out who have bank accounts overseas totaling over $10,000, with

steep penalties for non-compliance. They are planning eventually to share all these details between

governments so no one can escape paying whatever taxes they impose. If someone knows the name of

that form, please share it.

Thanks

[Sheryl]

I believe you are referring to FBAR. Though it hardly does all the things you mention. It simply shows what cash assets you have in foreign banks.

[mania]

Mania, I believe the U.S. is part of a global government movement to know the whereabouts and personal

details of every citizen under its control. This includes your income and bank accounts, wherever they are.

There is a form all U.S. citizens must fill out who have bank accounts overseas totaling over $10,000, with

steep penalties for non-compliance. They are planning eventually to share all these details between

governments so no one can escape paying whatever taxes they impose. If someone knows the name of

that form, please share it.

Thanks

Yes as Sheryl stated it is called FBAR (Foreign Bank and Financial Accounts)

it is setup for online filing only this year. Just did mine

It is actually the Treasury Department & not the IRS as many think.

Other than that yes I believe you are basically correct.

As countries sink further into debt they want to be sure & keep tabs on any pennies you

may be making & want assurance you have claimed them. Of course it is always under the guise of

anti-terrorism that these things are proposed.

But that said although the USA is one of the few if not the only country to make its citizens report disclose foreign account/file taxes

even while living abroad. They do not tax unless you make over 97k USD a year I think for 2013?

But even that is surprising given one who no longer lives in that country needs to pay taxes there.

Sadly? I am not one who makes enough to be taxed though

[Jingthing]

Here's a geeky question.

The 30 day thing.

I assume you can stay 30 day inclusive of the 30th day, correct, without triggering the not expat enough clause?

Or is it actually you can only stay 29 days and better not stay the 30th?

[mania]

Here's a geeky question.

The 30 day thing.

I assume you can stay 30 day inclusive of the 30th day, correct, without triggering the not expat enough clause?

Or is it actually you can only stay 29 days and better not stay the 30th?

Dont forget date/time changes

Brings up an interesting thought/question though,

After a few years here I am going back to visit family soon.

I will stay 23 days

Now later in the year suppose there is a emergency/death in the family/medical reason etc.

Will I need to make sure the total stays exactly below 30? Are there no allowances

in these rules for such emergencies.

[Sheryl]

The 30 day bit is only applicable if you do not qualify under the bona fide residence clause, which most expats living in Thailand would. And the definition of it is clearly laid out in the instructions for form 2555. Among other things you do not have to use the calendar year to calculate.

[mania]

The 30 day bit is only applicable if you do not qualify under the bona fide residence clause, which most expats living in Thailand would. And the definition of it is clearly laid out in the instructions for form 2555. Among other things you do not have to use the calendar year to calculate.

Thanks Sheryl that is interesting reading

Seems there are 2 tests

The Bona Fide residence test & the physical presence test

The Bona Fide being:

Whether you are a bona fide resident of

a foreign country depends on your

intention about the length and nature of

your stay. Evidence of your intention may

be your words and acts. If these conflict,

your acts carry more weight than your

words

The Physical being :

you must be a U.S.

citizen or resident alien who is physically

present in a foreign country, or countries

or at least 330 full days during any period

of 12 months in a row. A full day means

the 24-hour period that starts at midnight.

Clear enough even though the Bona Fide seems to b conflictable

& then would be judged by physical?

Not that big a deal but here is one folks should watch for

I know many here use fixed deposits at Thai banks & later at the end of the year

claim the taxes back. I did so myself a couple years ago but not since.

But...By doing so you are killing your US non resident claim I think...

Because when folks claim back the deducted from fixed accounts tax at the end of the year

that is the reason used

From form 2555 part II 13B

If you submitted a

statement of nonresidence to the

authorities of a foreign country in which

you earned income and the authorities

hold that you are not subject to their

income tax laws by reason of

nonresidency in the foreign country, you

are not considered a bona fide resident of

that country

Kind of a catch 22 as I know many use fixed deposits here & claim back the

taxes at the end of the year as I did in 2012.

To do that you file just such a statement as described above.

Edited February 26, 2014 by mania

[Jingthing]

What has "Obama Care" got to do with Thailand ?

It's about how American expats in THAILAND are impacted (or not) by the health insurance mandates imposed by the ACA (Obamacare). If you're not interested, don't read. Cheers.

[metisdead]

Troll posts have been removed, one troll has been removed as well.